Thyroid Nodular Pathology: From Molecular Research to Modern Therapeutic Perspective

Dear Colleagues,

Thyroid nodules are a very common occurrence in the general population, more common in females than males. In most cases, thyroid nodules are benign; however, even if benign, they can grow and cause compressive symptoms and cosmetic concerns that might require treatment. Approximately 5% of thyroid nodules are malignant; the remainder are colloid nodules, cysts and thyroiditis (80%), and benign follicular neoplasms (10–15%). Across the world, surgical removal of half or the whole thyroid gland represents the standard treatment for symptomatic benign thyroid nodules. Fine-needle aspiration biopsies (FNA) represent the gold standard for excluding the malignant nature of thyroid nodules. After cytomorphology, 20–30% of cases are deemed “indeterminate for malignancy” and undergo surgery. However, after thyroidectomy, 70–80% of these nodules are benign. This category of nodule formation requires the study of different molecular tests pointing to abnormal molecular mechanisms of thyroid cancer; examples such as genetic testing (BRAF, N-H-KRAS point mutations, and RET/PTC1, RET/PTC3, PAX8/PPAR rearrangements) or gene-expression classifiers have been proposed to improve the preoperative risk assessment of malignancy in thyroid FNAs. These biomolecular markers and genetic intramolecular mutations have a variable performance, and more studies are needed; in addition, their cost means they are far from being everyday approaches.

Minimally invasive treatments for the thyroid, including radiofrequency ablation (RFA) (which is generally performed using monopolar electrodes during the procedure), laser ablation (LA), high-intensity focused ultrasound (HIFU), and microwave ablation (MWA, have gained an increasing role in the management of symptomatic benign thyroid nodules, and in fact, all these treatments are included as therapeutic alternatives to surgical excision in several guidelines. However, despite the increasing evidence of the safety and efficacy of minimally invasive treatments for benign thyroid nodules, there are several variations in the application of the different available techniques among different countries. Recently, these techniques have also been under study for the treatment for thyroid microcinema, recurrence, and lymph node metastases, but data on these applications are still limited.

The aim of the present Special Issue is to identify and study how the biomolecular markers associated with nodular thyreopathy might represent the best approach in the common practice during FNAb and how those result might influence surgical approaches. Thus, it will hopefully reduce the necessity of this expensive surgical procedure in favor of a less invasive and expensive mini-invasive approach, as opposed to the cost of a more expensive but complete needle aspiration. In turn, this will help to identify the best procedures and follow-up for each type of nodular pathology, personalizing each treatment. The investigations we will focus our attention on are fundamentally cellular/molecular studies; papers only containing clinical trials/data are not acceptable.

Dr. Davide Francomano
Guest Editor

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• biomolecular thyroid investigation
• genetic test
• thyroid cancer biomarker discovery
• thyroid carcinoma
• laser ablation
• lymph nodes metastases
• recurrence of thyroid nodular pathology